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Öğe Böbrek Yaralanmasını Taklit Eden Nadir Bir Renal Kolik Olgusu : Koç Toslaması Sonrası Gelişen Renal Kolik(Çanakkale Onsekiz Mart Üniversitesi, 2014) Sancak, Eyüp Burak; Reşorlu, Mustafa; Akbaş, Alpaslan; Gülpınar, Murat TolgaHayvanlarla ilişkili travmalar, ciddi morbidite ve mortalite potansiyelinden dolayı, önemli bir tıbbi problemdir. Türkiyede hayvancılığın halen önemli bir geçim kaynağı oluşu, bu problemin riskini artırmaktadır. Koç saldırısı sonucu oluşan travma ile ilgili literatürde çok az veri vardır. Ancak hayvanla ilişkili travma sonrası renal kolik vakasına literatürde rastlanmamıştır. Biz burada genç erişkin bir hastada, koç saldırısı sonrası gelişen akut renal kolik olgusunu sunmayı planladık.Öğe Denizli ilinde ilköğretim çağındaki çocuklarda nokturnal enürezis prevalansı ve risk faktörleri(2013) Bolat, Deniz; Bolat, Elif; Sancak, Eyüp Burak; Başer, Aykut; Zencir, Mehmet; Sınık, ZaferÖzet Amaç: Bu çalışmada Denizli ilinde ilköğretim çağındaki çocuklarda nokturnal enürezis prevalansını ve bu durumla ilişkili risk faktörlerini araştırmak amaçlanmıştır. Gereç ve yöntem: Çalışma için Denizli İl Milli Eğitim Müdürlüğünün 30/03/2005 tarihli ve 8820 sayılı onayı alınmıştır. Denizli il merkezinden 8, ilçelerinden 6 ilköğretim okulu randomize olarak seçildi. Ailenin sosyodemografik özelliklerini, çocuğun tıbbi özgeçmişini içeren sorgulama formu ile beraber işeme alışkanlıklarını sorgulayan İşeme Bozuklukları Semptom Skoru Anketi yaşları 7-14 arasında olan 2353 ilköğretim öğrencisi çocuğun ebeveynleri tarafından dolduruldu. Bilinen nörolojik ya da ürolojik hastalık öyküsü olan çocuklar araştırma dışı bırakıldı. İstatistiksel yöntemler olarak tanımlayıcı, analitik ve lojistik regresyon analizi kullanıldı. Bulgular: Araştırmaya katılım hızı %91,9du (2164 kişi). Nokturnal enürezis toplam prevalansı %19,2 olmakla birlikte bu oran ilerleyen yaşla beraber düşme eğilimindeydi. Çocuğun okul başarısı, ailenin sosyoekonomik seviyesi, ebeveynlerin eğitim düzeyi, babanın mesleği, pozitif aile öyküsü, gündüz idrar kaçırma, geçirilmiş idrar yolu enfeksiyonu öyküsü, kabızlık ve disfonksiyonel işeme semptomları nokturnal enürezis ile istatistiksel olarak anlamlı ilişki göstermekteydi (p<0.05). Erkek cinsiyet, erken yaş, annenin düşük eğitim seviyesi ve pozitif aile öyküsü nokturnal enürezis için bağımsız risk faktörlerini oluşturmaktaydı. Sonuç: Nokturnal enürezis, ilköğretim çağındaki çocuklarda sık görülen önemli bir sağlık sorunudur. Enüretik çocukların tedavileri planlanırken bu durumla ilişkili risk faktörleri göz önünde bulundurulmalıdır. Bu çalışma, Türkçe validasyonu yapılmış bir semptom skoru ile, Türkiyedeki ilköğretim çağındaki çocuklarda nokturnal enürezis prevalansını değerlendiren ilk kesitsel çalışmadır.Öğe Determining the Stone Free Rate of Retrograde Intrarenal Surgery. Which Radiological Technique? RIRSearch Study Group(Elsevier Science Inc, 2024) Yazıcı, Cenk Murat; Gönen Korcan, Aysun; Ozman, Oktay; Çakır, Hakan; Başataç, Cem; Akgül, Hacı Murat; Çınar, Önder; Sıddıkoğlu, Duygu; Sancak, Eyüp BurakOBJECTIVE To evaluate the sensitivity and specificity of ultrasonography (USG) and kidney ureter bladder radiography (KUB) for the determination of stone-free status of retrograde intrarenal surgery (RIRS) according to different stone-free status definitions. MATERIALS AND METHODS The patients who underwent RIRS between September 2021 and September 2022 were prospectively included in the study. All patients underwent a KUB radiography, urinary system USG and noncontrast abdominal tomography at the postoperative first month of the surgery. The sensitivity, specificity, negative predictive factor, and positive predictive factor of USG and KUB on evaluating the stone-free rate were analyzed according to different stone-free status definitions. RESULTS A total of 178 patients were included in the study. The stone-free rates according to stone-free definitions as; residual stone < 4 mm, < 2 mm and no residual stone were 79.2%, 64.0%, and 56.7%, respectively. According to its definition as a residual stone < 4 mm, the sensitivity and specificity of USG were 64.9% and 84.3%, respectively. The sensitivity of USG was 57.1% and 52.5% as the definitions were residual stone < 2 mm and no residual stone, respectively. Addition of KUB to USG slightly increased the sensitivity but did not change the specificity. CONCLUSION USG had high specificity but low sensitivity for evaluating stone-free status after RIRS and addition of KUB did not increase the diagnostic efficacy. Although USG may be used in daily practice, it may overestimate the stone-free status and noncontrast abdominal tomography must be used during the clinical trials to document the exact stone-free rates of RIRS. (c) 2024 Elsevier Inc. All rights reserved.Öğe Does extracorporeal shock wave lithotripsy before retrograde intrarenal surgery complicates the surgery for upper ureter stone? The results of the RIRSearch group(Wiley, 2021) Yazıcı, Cenk Murat; Sıddıkoğlu, Duygu; Çınar, Önder; Özman, Oktay; Başataç, Cem; Akgül, Murat; Sancak, Eyüp Burak; Önal, Bülent; Akpınar, HalukAims: To evaluate the effect of pre-RIRS ESWL on the efficiency and safety of RIRS in the treatment of proximal ureter stones. Methods: The patients in the study population were divided into two groups. Group-1 was composed of patients who had undergone ESWL for proximal ureter stones before RIRS and Group-2 was composed of patients who directly underwent RIRS without any prior ESWL. The clinical and demographic properties of the patients were analysed in the RIRSearch database. The operative outcomes, peroperative complications, postoperative complications, hospitalisation time and stone-free rates were compared between the groups. Results: There were 56 patients in Group 1 and 95 patients in Group 2. The demographic and clinical properties were similar between the groups. The stone-free rates, peroperative complications and postoperative complications were also similar between the groups; however, the fluoroscopy time was significantly higher in Group 1 (P =.043). The cut-off duration of 10 weeks between ESWL and RIRS had reasonable/favourable discriminating ability, with a 51% sensitivity and 88% specificity rate for stone-free status. Conclusion: Performing ESWL on the proximal ureter stones before RIRS did not change the efficacy and safety of RIRS. The time between the patient's last ESWL session and RIRS had a predictive value for stone-free status, but did not have any effect on complications. © 2021 John Wiley & Sons LtdÖğe Enurezisli erişkin hastalarda biofeedback tedavisinin etkinliği(2016) Sancak, Eyüp Burak; Akbaş, Alpaslan; Alan, Cabir; Ersay, Ahmet ReşitAmaç: Çalışmanın amacı; primer monosemptomatik enurezisli (MsE) erişkinlerde, biofeedback tedavisinin etkinliğini araştırmaktır. Gereç ve Yöntemler: Prospektif dizaynlı bu çalışmada, primer MsE'li erişkin hastalar çalışmaya dahil edildi. Nörojen mesaneli, gündüz işeme problemi olan, anatomik anomalisi olan ve enurezisle ilişkili başka hastalığı olan hastalar çalışmaya alınmadı. Kriterlere uyan 13 hastanın demografik verileri kaydedildi. Biofeedback öncesinde ve tedavinin bitiminden sonra 3. ayda, hastaların enurezis sıklıkları, üroflovmetri değerleri, rezidüel idrar miktarları (PVR) ve total mesane hacmi (TMH) (işeme hacmi + PVR) değerlendirildi. Biofeedback tedavinin başarısı, ayda bir kez veya daha az gece ıslatması olarak tanımlandı. Bulgular: Altı erkek ve yedi kadını içeren toplam 13 hastanın yaş ortalaması 29.2 ± 8.2 idi. Biofeedback tedavisi öncesinde aylık enurezis sıklığı 23.4 ± 5.9 iken, tedavi sonrasında 5.2 ± 8.9 olarak hesaplandı (p=0.002). Biofeedback tedavisi öncesi ve sonrasında; PVR, maksimum idrar akım hızı (Qm) ve ortalama akım hızı (Qa) açısından fark saptanmadı. Biofeedback tedavisi sonrası, TMH'nin 277.8 ml'den 329.9 ml'ye yükseldiği belirlendi (p=0.001). Sonuç: Primer MsE olan erişkin hastalarda biofeedback tedavisi, güvenli basit ve kolay uygulanabilen bir tedavi seçeneğidir. Mesane kapasitesini artırdığı saptanan bu tedavi, bu özel hasta grubu için önerilebilir.Öğe The Impact of Stone Density on Operative Complications of Retrograde Intrarenal Surgery: A Multicenter Study with Propensity Score Matching Analysis(Mary Ann Liebert Inc., 2022) Başatac, Cem; Özman, Oktay; Akgül, Hacı Murat; Özyaman, Onur; Çınar, Önder; Can, Günay; Sancak, Eyüp BurakBackground: The aim of the study was to evaluate the impact of stone density on operative complication rates in retrograde intrarenal surgery (RIRS). Materials and Methods: A total of 473 consecutive patients undergoing RIRS for the treatment of upper tract urinary stones were included. To adjust for baseline confounders, one-to-one propensity score matching was performed. After matching, the patients were divided into two groups according to stone density (low density [LD] group, ≤970 Hounsfield unit [HU]; high density [HD] group, >970 HU). The patients' demographics, stone-related features, stone-free rates, and intraoperative and postoperative complication rates were compared between the groups. The primary objective was to evaluate whether the intraoperative and postoperative complication rates were higher in patients whose stone density was greater than 970 HU. Results: After propensity score matching, 170 of 210 LD and 170 of 263 HD patients undergoing RIRS were included. The baseline characteristics did not differ significantly between the groups. There were no significant differences between LD and HD patients with respect to intraoperative (5.9% and 8.8%, respectively; P = .29), postoperative (10.6% and 15.3%, respectively; P = .14), and overall complication rates (15.2% and 21.1%, respectively; P = .16). Stone-free status was achieved in 143 patients (84.1%) in the LD group and 148 patients (87%) in the HD group; the difference was not statistically significant (P = .27). Conclusion: Our results show that RIRS is a safe and effective minimally invasive procedure for the treatment of upper urinary tract stones, even in HD stones.Öğe Karyotipik bozukluk gösteren intratestiküler leyomiyom(2015) Gülpınar, Murat Tolga; Akbaş, Alpaslan; Sancak, Eyüp Burak; Aydın, Hatip; Reşorlu, Mustafa; Özkanlı, Sıdıka Şeymaİntratestiküler leyomiyom benign karakterli ve nadir görülen bir skrotal kitle sebebidir. Preoperatif klinik bulgular ile malign bir testiküler kitleden ayrımı mümkün olmamaktadır. Bu durum benign karakterdeki bir tümör nedeniyle testis kaybına yol açmaktadır. Klinik olarak malign-benign ayrımı yapılamayan şüpheli durumlarda peroperatif yapılacak frozen inceleme ile doğru tanı ve tedavi yapılabilir. Erkeklerde düz kas dokusu kaynaklı benign tümörlerde karyotipik anormallik görülmesi son derece ender bildirilen bir durumdur. Leyomiyom patogenezinin altında yatan moleküler mekanizmaların henüz anlaşılamamış olması saptanan karyotipik anomalilerin önemini arttırmaktadır.Öğe Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: Results of propensity score matching study(Elsevier, 2021) Özman, Oktay; Akgül, Hacı Murat; Basatac, Cem; Çınar, Önder; Sancak, Eyüp Burak; Yazıcı, Cenk Murat; Önal, Bülent; Akpınar, HalukThe aim of this study is to evaluate the effect of ureteral access sheath (UAS) use and calibration change on the success and complications of retrograde intrarenal surgery (RIRS)Öğe Protective effect of metformin on lithium-induced nephrogenic diabetes insipidus: An experimental study in rats(Wroclaw University of Medicine, 2021) Taş, Halil İbrahim; Sancak, Eyüp BurakBackground. Lithium is widely used in the treatment of bipolar disorders and may lead to nephrogenic diabetes insipidus (NDI), following long-term treatment. Metformin is considered the preferred initial therapy for patients with type 2 diabetes mellitus (T2D). Objectives. To investigate the protective effect of metformin on the kidney damage caused by lithium administration. Materials and methods. Using an animal model of chronic lithium-induced NDI, rats were divided into 4 groups: sham, metformin, lithium, and lithium + metformin. The effects of these treatments were examined using serum electrolytes, blood and tissue total antioxidant status, total oxidant status, the oxidative stress index, urine and blood osmolality, and tissue aquaporin-2 (AQP2) levels. Additionally, histopathological changes, including congestion, hydropic swelling, tubular necrosis, tubular atrophy, and Bowman’s capsule dilatation, were evaluated. The total histopathological score was obtained by summing the scores for each pathological finding. Results. In the lithium group, biochemical variables indicating NDI, including sodium, chloride and blood osmolality, increased, and urine osmolality decreased, compared to the sham group. With metformin treatment, the blood osmolality decreased from 328.17 mOsm/kg to 306.33 mOsm/kg, and urine osmolality increased from 349.67 mOsm/kg to 754.50 mOsm/kg (p = 0.004 and p = 0.001, respectively). Tissue AQP2 levels decreased with lithium administration but stabilized with metformin treatment. Additionally, in comparison to the lithium group, the total histopathological score in the metformin group declined from 8.0 to 2.0 (p = 0.002). Conclusions. Metformin may help protect the kidneys from lithium-induced NDI through the AQP2 regulating effect and a reduction in oxidative stress.Öğe The effect of optical dilatation before retrograde intrarenal surgery on success and complications: Results of the RIRSearch group study(Wiley, 2021) Sancak, Eyüp Burak; Başataç, Cem; Akgül, Hacı Murat; Çınar, Önder; Özman, Oktay; Yazıcı, Cenk Murat; Akpınar, HalukAim The guidelines propose optical dilatation before retrograde intrarenal surgery (RIRS), but there are currently no evidence-based studies concerning the impact of optical dilatation with semirigid ureteroscopy (sURS). The aim of this study was to evaluate the effect of optical dilatation through sURS prior to the RIRS procedure on the success and complications of RIRS. Methods A total of 422 patients were included in the retrospective multicentre study. The patients were divided into two groups according to whether sURS was to be performed. Patients' demographics, stone parameters and operative outcomes were compared. Surgical success was defined as no or up to 3-mm residual stone fragments without the need for additional procedures. The independent predictors for surgical success were determined with a multivariable logistic regression model. Results Of the 422 patients, 133 (31.5%) were in the sURS group and 289 (68.5%) were in the non-sURS group. Stone characteristics and patients' demographics were similar between the groups. Operation time in the sURS group was significantly longer (compared with the non-sURS group, P < .0001). A ureteral access sheath (UAS) could not be placed in four (3.0%) patients in the sURS group, nor in 25 (8.7%) patients in the non-sURS group (P = .03). Compared with the non-sURS group, the intraoperative complication rate was lower in the sURS group (14 [4.8%] vs 1 [0.8%], P = .04). The surgical success rate was higher in the sURS group (P = .002). Nevertheless, sURS had no independent effect on surgical success. We found two independent predictors for surgical success rate: stone number (P < .0001, OR:2.28) and failed UAS placement (P = .035, OR:3.49). Conclusions Optical dilatation with sURS before RIRS increases surgical success by raising the rate of UAS placement and reducing the rate of intraoperative complications. We suggest that this method can be routinely applied to patients who have not been passively dilated with a JJ stent.Öğe The Effect of Ureteral Access Sheath Use/Caliber Change on Outcomes of Retrograde Intrarenal Surgery, Short-Term Kidney Functions, Radiation Exposure, Ureteroscope Lifetime, and Factors Predicting Insertion Failure: A RIRSearch Study(Mary Ann Liebert Inc., 2024) Özman, Oktay; Akgül, Murat; Başaataç, Cem; Cakır, Hakan; Çınar, Önder; Sancak, Eyüp BurakBackground: The aim of this study was (1) to explore effect of ureteral access sheath (UAS) use on primary retrograde intrarenal surgery (RIRS) outcomes, short-term kidney functions, radiation exposure, and ureteroscope lifetime (URS-LT) and (2) to reveal factors that predict UAS insertion failure.Materials and Methods: Patients (n = 1318) who underwent RIRS without UAS (Group 1), those who had operation with a <11-13 Fr (Group 2), and those with a >= 11-13 Fr UAS were matched (1:1:2) and compared. Stone-free rate (SFR), intra- and postoperative complications, acute kidney injury (AKI), fluoroscopy time, URS-LT, and UAS insertion failure were the outcomes.Results: SFR, which was highest in Group 3 (75%, 71% and 87.3%, respectively; P = .001), was significantly associated with use of >= 11-13 Fr (odds ratio [OR]: 4.2, P < .001), but was not with use of <11-13 Fr UAS (OR: 1.3, P = .3). Group 3 had less need for auxiliary procedure (15%, 16%, and 7.4%, respectively; P = .03). Five percent of patients had a risk of AKI, but only 0.3% developed AKI. Although UAS use was protective against creatinine increase (OR: 0.65, P = .02), increased risk of AKI waas only associated with female gender (OR: 5.5, P < .001). Fluroscopy times were 5, 15, and 87 sn, respectively (P < .001). Short URS-LT was strongly associated with high frequency of lower calix stones (r = -0.94, P = .005), but URS-LT was not correlated with sheathless case rate (r = 0.59, P = .22). UAS insertion success in first attempt was more likely in younger (OR: 0.99, P = .03), hydronephrotic (OR: 3.4, P < .001), and female cases (OR: 1.5, P = .008). But absolute UAS insertion failure was associated with female gender (OR: 2.7, P = .017).Conclusions: Not any UAS use but a higher caliber UAS use may improve SFR and protect against AKI after RIRS. Although UAS insertion failure is seen mostly in men, it may be more challenging in women owing to less efficacy of preoperative Double-J stent.Öğe The Predictive Factors for Readmission and Rehospitalization After Retrograde Intrarenal Surgery: The Results of RIRSearch Study Group(Mary Ann Liebert Inc., 2022) Doğan, Çağrı; Yazıcı, Cenk Murat; Akgül, Hacı Murat; Özman, Oktay; Başatac, Cem; Çınar, Önder; Sıddıkoğlu, Duygu; Çakır, Hakan; Sancak, Eyüp BurakPurpose: Retrograde intrarenal surgery (RIRS) is a safe and effective treatment option for upper urinary tract stones smaller than 2 cm. Although several studies have documented perioperative and postoperative complications related to RIRS, there exists limited data regarding the readmission and rehospitalization of patients after RIRS. The aims of the study were to document the rates of readmission and rehospitalization after RIRS and to determine the predictive factors for readmission and rehospitalization. Materials and Methods: In this study, we retrospectively analyzed patients who underwent RIRS for the treatment of renal stone disease and were unexpectedly readmitted to the hospital within 30 days after discharge. The hospital admission systems were used to determine readmissions and rehospitalizations. Readmission and rehospitalization rates, causes, and treatment procedures were evaluated. Univariate and multivariate analyses of clinicodemographic properties were performed to evaluate possible predictive factors for readmission and rehospitalization after RIRS. Results: A total of 1036 patients were included in the study. Of these patients, 103 (9.9%) were readmitted to the hospital. Among these readmissions, 35 patients (33.9%) were rehospitalized and 14 (13.6%) underwent surgical intervention. The most common reasons for readmission were renal colic and fever. The presence of preoperative pyuria (odds ratio [OR] 1.86), stone volume (OR 1.54), postoperative complications (OR 3.66), and stone-free status (OR 0.46) were predictive factors for readmission, whereas hospitalization time (OR 1.32), postoperative complications (OR 9.70), and stone-free status (OR 0.06) were predictive factors for rehospitalization after RIRS. Conclusion: Nearly 10% of patients who underwent RIRS were readmitted to the hospital within the first month after discharge, and some were rehospitalized. Preoperative pyuria, high stone volume, presence of postoperative complications, and low stone-free status predicted this readmission and rehospitalization. Clinicians must recognize these predictive factors and inform their patients about this possibility.
